去甲肾上腺素与布地奈德联合雾化吸入治疗小儿重度喉梗阻疗效观察

Observation on the Efficacy of Children with Severe Laryngeal Obstruction by Inhaling Jointly Norepinephrine and Budesonide Atomization

目的探讨去甲肾上腺素联合布地奈德氧驱动雾化吸入治疗小儿急性喉炎伴喉梗阻的临床疗效及不良反应。方法将98例急性喉炎合Ⅲ度及Ⅳ度喉梗阻患儿随机分为观察组48例,对照组50例。观察组立即依次给予去甲肾上腺素（1∶100 000）、布地奈德（1∶10 000）3 ml,加入氧气驱动雾化吸入器雾化吸入治疗,氧流量4-6 L/min,每2 h雾化吸入治疗1次,每次吸入10-20 min。对照组只给予布地奈德（1∶10 000）雾化吸入治疗,方法与观察组相同。两组患儿均给予甲泼尼龙0.5-2.0 mg/（kg·bw）静脉滴注,疗程3 d;同时给予抗感染、止咳、化痰、补液、维持内环境稳定等综合对症治疗。结果观察组患儿在雾化吸入1-2次后有效,3-4次后显效,疗效明显优于对照组（P〈0.05）。观察组患儿用药后无心力衰竭、心律失常、少尿、头痛、呕吐等不良反应。结论氧气驱动雾化吸入去甲肾上腺素、布地奈德抢救Ⅲ度或Ⅳ度喉梗阻疗效明显、安全,可尽量避免气管切开,且不良反应小,值得临床推广应用。

Objective To discuss the clinical efficacy and adverse effect on children with severe laryngeal obstruction treated by inhaling jointly norepinephrine and budesonide atomization. Methods Inpatient children were sorted randomly into observation group and control group. Children in observation group were treated with 3 ml norepinephrine（1∶ 100 000） and budesonide atomization（ 1 ∶ 10 000） in turn,adding oxygen to drive atomized inhaler and therapy,with oxygen flow4-6 L / min. Atomization inhalation in the treatment was set every 2 hours once and 10-20 minutes for each inhalation. Children in control group were only treated with budesonide atomization（1∶ 10 000）,all the other clinical methods were taken the same way for both groups. Children in both groups were given intravenous infusion of methylprednisolone 0. 5 to2. 0 mg /（ kg·bw）,with course of 3 days,while symptomatic treatment were taken to maintain a stable internal environment,such as anti-infection,relieving cough,reducing phlegm,fluid infusion,etc. Results Children in observation group were found treatment effective after inhaling 1-2 times,and excellent effect were shown after 3-4 treatment,compared with the control group（ P〈0. 05）. Children in observation group were found no heart failure,arrhythmias,oliguria,headache,vomiting and other adverse effects after administration. Conclusion Norepinephrine combined with budesonide inhalation by oxygen driving rescuing Ⅲ degrees or Ⅳ laryngeal obstruction showed obvious curative effect and security. This method can avoid trachea incision,get less adverse reaction,and is worthy of clinical popularization and application.